ABSTRACT
BACKGROUND: The impact of neoadjuvant chemotherapy (NACT) on immediate free flap breast reconstruction remains controversial. Furthermore, the oncological outcomes of immediate free flap breast reconstruction after skin-sparing mastectomy (SSM) following NACT remain unclear. This study aimed to investigate the surgical complications and oncological outcomes of immediate perforator flap reconstruction after SSM following NACT. METHODS: A total of 201 consecutive patients with indications for immediate perforator flap reconstruction after SSM were included between 2004 and 2012. Surgical and oncological outcomes were compared between patients with and without NACT. RESULTS: There were 38 patients in the NACT group and 163 in the non-NACT control group. The median age of the NACT group was 39.5 years, which was significantly younger than the control group (43.0 years; P < 0.05). Patients in the NACT group also had more advanced and aggressive disease (P < 0.05). There was no significant difference in the frequency of surgical complications between the groups, no difference in the type of complications, and no significant difference in the frequencies of major and minor complications. No patients in the NACT group had delayed adjuvant therapy. Eight patients (4%) developed recurrences, with a median follow-up time of 3.0 years. Local recurrences occurred in three control patients but no patients in the NACT group. CONCLUSION: NACT does not affect short-term or interim outcomes after immediate perforator flap reconstruction and may thus represent a safe and practical treatment option for the multidisciplinary treatment of breast cancer.
Subject(s)
Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/surgery , Carcinoma, Intraductal, Noninfiltrating/surgery , Carcinoma, Lobular/surgery , Mammaplasty/methods , Mastectomy, Subcutaneous/methods , Neoadjuvant Therapy , Perforator Flap , Adult , Antibodies, Monoclonal, Humanized/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Carboplatin/therapeutic use , Carcinoma, Ductal, Breast/drug therapy , Chemotherapy, Adjuvant , Cohort Studies , Cyclophosphamide/therapeutic use , Docetaxel , Epirubicin/therapeutic use , Etoposide/therapeutic use , Female , Fluorouracil/therapeutic use , Humans , Middle Aged , Paclitaxel/administration & dosage , Retrospective Studies , Taxoids/administration & dosage , Trastuzumab , Treatment Outcome , Young AdultABSTRACT
A patient with chronic schizophrenia, who had been treated for a long time with chlorpromazine, haloperidol, levodopa, benserazide hydrochloride, diazepam and biperiden, developed extreme hypothermia (about 32 degrees C) when the dose of haloperidol was increased because of a deterioration of the patient's mental symptoms. No other physical manifestations were observed, except bradycardia. The turnover of noradrenaline in the cerebrospinal fluid and blood was increased in association with the hypothermia in this patient. A hypothesis about the involvement of monoamine imbalance in changes in body temperature is discussed.
Subject(s)
Haloperidol/adverse effects , Hypothermia/chemically induced , Schizophrenia/drug therapy , Antipsychotic Agents/therapeutic use , Dose-Response Relationship, Drug , Drug Therapy, Combination , Humans , Male , Middle Aged , Neuroleptic Malignant Syndrome/etiology , Treatment OutcomeABSTRACT
In a schizophrenic patient, hypothermia was caused by combined treatment with zotepine, biperiden, and fluphenazine, although combined treatment with zotepine and biperiden had caused no side effects. Other side effects closely resembled those in neuroleptic malignant syndrome.
